today ADHA Annual Session Nashville June 20

clinical news Hygiene Tribune U.S. Edition | June 20, 20154 ten linked to breaches in the practice of standard precautions.2 Once-rare viruses now in headlines Emerging and re-emerging infectious diseases present a real challenge to all health-care providers. Three of the more than 50 emerging and re-emerging infectious diseases identified by the Centers for Disease Control and Preven- tion and the World Health Organization (WHO) include Ebola virus disease (EVD), pandemic influenza and severe acute re- spiratory syndrome.3,4 These previously rare or unidenti- fied infectious diseases burst into the headlines in the past several years when they exhibited novel or uncharacteristic transmission patterns. Concern about emerging infectious diseases arises for several reasons. When faced with a particularly deadly infec- tious disease such as EVD, which can be spread through contact with an ill pa- tient’s body fluids, health-care workers are naturally concerned about how to protect themselves if an ill patient pres- ents to the dental clinic. With diseases such as pandemic in- fluenza and severe acute respiratory syndrome, which may be spread via in- halation of aerosolised respiratory fluids when a patient coughs or sneezes, the concern is whether standard precautions will be adequate. In addition to standard precautions, treating patients with these diseases re- quires the use of transmission-based pre- cautions. These encompass what are re- ferred to as contact, droplet and airborne precautions for diseases with those spe- cific routes of transmission. Transmission-based precautions may include patient isolation, placing a surgi- cal mask on the patient when he or she is around other people, additional protec- tive attire for care providers and, in some cases, the use of respirators and negative air pressure in a treatment room. In most cases, patients who are conta- gious for infections requiring droplet or airborne precautions should not be treat- ed in a traditional dental clinic setting. Treatment delay can be best policy Updating a patient’s medical history at each visit will assist dental health pro- fessionals in identifying patients who are symptomatic for infectious diseases. Patients with respiratory symptoms, including productive cough and fever, should have their dental treatment de- layed until they are no longer symptom- atic. Additionally, health-care profession- als who are symptomatic should refrain from coming to work until they have been free of fever without taking fever- reducing medication for 24 hours. In most cases, a patient with symptoms as severe as those experienced with EVD will not present for dental care and there- fore extraordinary screening and protec- tion protocols are not recommended. If a patient is suspected of having a highly contagious disease, he or she should be referred to a physician, hospital or public health clinic. Protect yourself and patients with vaccinations, proper hand hygiene Dental professionals should take action to remain healthy by being vaccinated according to accepted public health guidelines, understanding that the rec- ommendations may differ according to country of residence. Performing hand hygiene procedures at the beginning of the day, before plac- ing and after removing gloves, changing gloves for each patient, wearing a clean mask and gown or laboratory coat, and wearing protective eyewear are all posi- tive actions that help prevent occupa- tional infections. In addition, cleaning and heat steril- ization of all instruments and disinfec- tion of clinical surfaces ensure a safe environment for patients. There is solid evidence that dental care is safe for patients and providers when standard precautions are followed, but patients and dental health-care workers are placed at risk when precautions are compromised and breaches occur. ÿ References 1. CDC. Occupational HIV Transmission and Prevention Among Health Care Workers. Fact Sheet. 2014 (Jan) www.cdc.gov/hiv/ risk/other/occupational.html. Accessed Jan. 20, 2015. 2. Radcliffe RA1, Bixler D, Moorman A, Hogan VA, Greenfield VS, Gaviria DM, Patel PR, Schaefer MK, Collins AS, Khudyakov YE, Drobeniuc J, Gooch BF, Cleveland JL. Hepa- titis B virus transmissions associated with a portable dental clinic, West Virginia, 2009. J Am Dent Assoc. 2013 Oct;144(10):1110-8. 3. CDC. Infectious Disease Information. Emerging Infectious Diseases. www.cdc. gov/ncidod/diseases/eid/disease_sites.htm. Accessed Jan. 20, 2015. 4. WHO. Pandemic and Epidemic Diseases. www.who.int/csr/disease/en/. Accessed Jan. 20, 2015. Eve Cuny is the director of environmental health and safety and associate professor at Pacific Dugo- ni School of Dentistry in San Francisco. She is a con- sultant to the ADA Council on Scientific Affairs and expert reviewer to the Centers for Disease Control and Prevention. Cuny is past chairperson of the Or- ganization for Safety, Asepsis and Prevention (OSAP) and is a member of the National Occupa- tional Research Agenda Council with the U.S. De- partment of Health and Human Services. She has published articles and textbook chapters on safety and infection control and presented numerous con- tinuing education programs domestically and in- ternationally. Figs 1–7: Steps from the Centers for Disease Control and Prevention for disposable-glove removal. Latex, vinyl or nitrile gloves reduce hand contamination, prevent cross-contamination and protect against infection. Gloves shouldn’t restrict movement, must accommodate individuals (i.e., allergies) and meet the requirements of the task performed. Photos/Kimberly Smith, CDC Step 1: Pinch the palm of the left glove and begin to pull glove down to fingers. Step 2: Continue to pull the palm of the left glove down and off your fingers. Step 3: After the glove is pulled off, form it into a ball in the fist of your right hand. Step 4: Insert two fingers of the left hand under the rim of your right glove on palm side. Step 5: With the left hand, push the glove down the right palm covering the balled glove. Step 6: Grasp gloves with left hand and remove them from your right hand. Step 7: Discard the gloves into an infectious waste container and wash your hands. “ DISEASES, Page 3

today ADHA Annual Session Nashville June 20

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